PI‐RADS: Past, present, and future

Gupta, Rajan T.; Mehta, Kurren; Türkbey, Barış; Verma, Sadhna

doi:10.1002/jmri.26896

Cited by 51 publications

(46 citation statements)

References 103 publications

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“…Even though in the meanwhile numerous studies converge to the conclusion that gadolinium could be omitted without hampering the diagnostic accuracy of MRI, the use of gadolinium enhancer is a matter of debate [27] and a recommendation in the current prostate imaging guidelines [7,8,50]. With our contribution, we opt to strengthen the cumulating evidence towards the optimization of the upcoming guidelines for prostate diagnostics.…”

Section: Discussionmentioning

confidence: 99%

The role of gadolinium in magnetic resonance imaging for early prostate cancer diagnosis: A diagnostic accuracy study

et al. 2019

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ObjectiveProstate lesions detected with multiparametric magnetic resonance imaging (mpMRI) are classified for their malignant potential according to the Prostate Imaging-Reporting And Data System (PI-RADS™2). In this study, we evaluate the diagnostic accuracy of the mpMRI with and without gadolinium, with emphasis on the added diagnostic value of the dynamic contrast enhancement (DCE).Materials and methodsThe study was retrospective for 286 prostate lesions / 213 eligible patients, n = 116/170, and 49/59% malignant for the peripheral (Pz) and transitional zone (Tz), respectively. A stereotactic MRI-guided prostate biopsy served as the histological ground truth. All patients received a mpMRI with DCE. The influence of DCE in the prediction of malignancy was analyzed by blinded assessment of the imaging protocol without DCE and the DCE separately.ResultsSignificant (CSPca) and insignificant (IPca) prostate cancers were evaluated separately to enhance the potential effects of the DCE in the detection of CSPca. The Receiver Operating Characteristics Area Under Curve (ROC-AUC), sensitivity (Se) and specificity (Spe) of PIRADS-without-DCE in the Pz was 0.70/0.47/0.86 for all cancers (IPca and CSPca merged) and 0.73/0.54/0.82 for CSPca. PIRADS-with-DCE for the same patients showed ROC-AUC/Se/Spe of 0.70/0.49/0.86 for all Pz cancers and 0.69/0.54/0.81 for CSPca in the Pz, respectively, p>0.05 chi-squared test. Similar results for the Tz, AUC/Se/Spe for PIRADS-without-DCE was 0.75/0.61/0.79 all cancers and 0.67/0.54/0.71 for CSPca, not influenced by DCE (0.66/0.47/0.81 for all Tz cancers and 0.61/0.39/0.75 for CSPca in Tz). The added Se and Spe of DCE for the detection of CSPca was 88/34% and 78/33% in the Pz and Tz, respectively.ConclusionDCE showed no significant added diagnostic value and lower specificity for the prediction of CSPca compared to the non-enhanced sequences. Our results support that gadolinium might be omitted without mitigating the diagnostic accuracy of the mpMRI for prostate cancer.

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Section: Discussionmentioning

confidence: 99%

The role of gadolinium in magnetic resonance imaging for early prostate cancer diagnosis: A diagnostic accuracy study

et al. 2019

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“…4 and 5); therefore, providing the necessary infrastructure for process automation to be integrated into the routine workflow. Along with the improved accessibility and evaluability of clinical data, this facilitates the deployment of radiomics and artificial intelligence to support clinical decision-making [3]. However, successful implementation of advanced software applications requires distinct technical set-ups which cannot be provided in all clinical settings.…”

Section: Report Standardizationmentioning

confidence: 99%

“…While PI-RADS v2.0 was able to enhance its accuracy from 81 to 93% and its sensitivity from 76 to 96% for TZ lesions compared to PI-RADS v1 [64], diagnosis of TZ lesions remained challenging compared to lesions within the PZ (Table 1). Therefore, more detailed criteria for nodules within the TZ were introduced in PI-RADS v2.1 leading to improved diagnostic accuracy and reduced interpretation variabilities in this area [3]. For instance, nodules commonly associated with agerelated benign prostatic hyperplasia (BPH) were previously assigned as PI-RADS category 2 lesions, whereas PI-RADS v2.1 now classifies these nodules into PI-RADS category 1 on T2w imaging (Fig.…”

Section: Pi-rads Version 21mentioning

confidence: 99%

“…Therefore, mpMRI was established as a principle non-invasive imaging technique to support PCa diagnosis, characterization, surveillance, and biopsy guidance. The implementation of a multiparametric MRI protocol led to a migration of PCa detection into earlier stages of the disease providing additional information about tumor aggressiveness in addition to anatomical information [3].…”

Section: Introductionmentioning

confidence: 99%

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Multiparametric prostate MRI and structured reporting: benefits and challenges in the PI-RADS era

Mir-Bashiri¹,

Yaqubi

Woźnicki

et al. 2021

Chin J Acad Radiol

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Prostate cancer (PCa) is the second most frequent cancer diagnosis in men and the sixth leading cause of cancer death worldwide with increasing numbers globally. Therefore, differentiated diagnostic imaging and risk-adapted therapeutic approaches are warranted. Multiparametric magnetic resonance imaging (mpMRI) of the prostate supports the diagnosis of PCa and is currently the leading imaging modality for PCa detection, characterization, local staging and image-based therapy planning. Due to the combination of different MRI sequences including functional MRI methods such as diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI), mpMRI enables a high sensitivity and specificity for the detection of PCa. The rising demand for individualized treatment strategies requires methods to ensure reproducibility, completeness, and quality of prostate MRI report data. The PI-RADS (Prostate Imaging Reporting and Data System) 2.1 classification represents the classification system that is internationally recommended for MRI-based evaluation of clinically significant prostate cancer. PI-RADS facilitates clinical decision-making by providing clear reporting parameters based on clinical evidence and expert consensus. Combined with software-based solutions, structured radiology reports form the backbone to integrate results from radiomics analyses or AI-applications into radiological reports and vice versa. This review provides an overview of imaging methods for PCa detection and local staging while placing special emphasis on mpMRI of the prostate. Furthermore, the article highlights the benefits of software-based structured PCa reporting solutions implementing PI-RADS 2.1 for the integration of structured data into decision support systems, thereby paving the way for workflow automation in radiology.

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“…Studies show that bpMRI has yielded good results in large centers [27,28]. bpMRI is also faster and more cost-effective than mpMRI, a fact that must be taken into consideration in light of the significantly increasing number of cases [29]. Moreover, since contrast agents containing gadolinium are not used, the ▶ Fig.…”

Section: Multiparametric or Biparametric Mri?mentioning

confidence: 99%

PI-RADS 2.1 – Image Interpretation: The Most Important Updates and Their Clinical Implications

Beyer

Weber

Thierfelder

2020

Rofo

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Background Multiparametric magnetic resonance imaging (MRI) of the prostate plays a central role in the diagnosis of patients with suspected prostate cancer. The increasing distribution and application of the guideline for the standardization of image acquisition, evaluation, and reporting (Prostate Imaging – Reporting and Data System, PI-RADS), which was updated in 2019 to version 2.1, contributes to the success of the technique. Materials and Methods The most important updates of PI-RADS version 2.1 presented in 2019 compared to the previous version PI-RADS 2.0 are highlighted and interpreted with regard to their clinical implications. Results PI-RADS version 2.1 aims to simplify the application of the scoring scheme without changing the basic concept of dominant sequences (DWI in the peripheral zone, T2 in the transition zone). Of particular importance are the increasing role of diffusion-weighted imaging in the transition zone, the now mandatory high b-value of at least 1400 s/mm2, and new information on the assessment of the central zone and the anterior fibromuscular stroma. Conclusion PI-RADS version 2.1 published in 2019 addresses a number of changes to the previous version, including both the examination technique and image interpretation. Prospective clinical studies have yet to prove the extent to which the goals of reducing interreader variability and increasing the detection rate in the transition zone will be achieved. Key Points: Citation Format

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PI‐RADS: Past, present, and future

Cited by 51 publications

References 103 publications

The role of gadolinium in magnetic resonance imaging for early prostate cancer diagnosis: A diagnostic accuracy study

The role of gadolinium in magnetic resonance imaging for early prostate cancer diagnosis: A diagnostic accuracy study

Multiparametric prostate MRI and structured reporting: benefits and challenges in the PI-RADS era

PI-RADS 2.1 – Image Interpretation: The Most Important Updates and Their Clinical Implications

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